Hindawi Publishing Corporation Case Reports in Urology Volume 2016, Article ID 7050981, 4 pages http://dx.doi.org/10.1155/2016/7050981
Case Report Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma Hidekazu Yoshie, Ryuto Nakazawa, Wataru Usuba, Hiroya Kudo, Yuichi Sato, Hideo Sasaki, and Tatsuya Chikaraishi Department of Urology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan Correspondence should be addressed to Hidekazu Yoshie; [email protected] Received 16 March 2016; Accepted 8 May 2016 Academic Editor: Giorgio Carmignani Copyright © 2016 Hidekazu Yoshie et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.
1. Introduction
2. Case Report
Dermatomyositis is a connective tissue disorder caused by perivascular inflammation in the skeletal muscles. Clinical manifestations include muscle weakness and skin lesions such as heliotrope rash and Gottron’s papules. Approximately 20% of patients with dermatomyositis reportedly show concomitant malignancies, including breast, colon, ovarian, and lung cancers [1]. We recently encountered a dermatomyositis patient with metastatic seminoma, which is extremely rare as an accompanying tumor. Of note was the finding that symptoms of dermatomyositis did not resolve with orchiectomy and steroids but resolved fully with chemotherapy started despite the unstable condition of the patient. We report here the unique clinical course of this patient with dermatomyositis accompanied by metastatic seminoma along with a review of the literature.
A 70-year-old man presented to the Department of Internal Medicine at our hospital complaining of muscle weakness of the extremities, erythema, and impaired gait, which had rapidly deteriorated since 1 month earlier. Muscle weakness was assessed as MMT 2/5, and he was bedridden with PS grade 3. Based on these clinical findings, dermatomyositis was suspected. Skin biopsy confirmed the diagnosis of dermatomyositis. Whole-body CT was performed as a routine screening for neoplasm, revealing a lesion in the left testis and systemic enlargement of the lymph nodes (Figure 1(a)). The patient was therefore referred to the Department of Urology with a diagnosis of paraneoplastic dermatomyositis with testicular tumor. Serum levels of CK and aldolase, both representing myogenic enzymes that serve as serum markers for dermatomyositis, were increased to 2621 U/L and 19.1 IU/L,
2
Case Reports in Urology
(a)
(b)
Figure 1: (a) Abdominal CT showing enlarged para-aortic lymph nodes. (b) After four courses of EP, enlarged lymph nodes have completely disappeared.
respectively. In terms of markers for testicular tumor, serum LDH was elevated to 1033 U/L, whereas HCG-𝛽 and AFP levels were within the normal ranges of
Case Report Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma Hidekazu Yoshie, Ryuto Nakazawa, Wataru Usuba, Hiroya Kudo, Yuichi Sato, Hideo Sasaki, and Tatsuya Chikaraishi Department of Urology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan Correspondence should be addressed to Hidekazu Yoshie; [email protected] Received 16 March 2016; Accepted 8 May 2016 Academic Editor: Giorgio Carmignani Copyright © 2016 Hidekazu Yoshie et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.
1. Introduction
2. Case Report
Dermatomyositis is a connective tissue disorder caused by perivascular inflammation in the skeletal muscles. Clinical manifestations include muscle weakness and skin lesions such as heliotrope rash and Gottron’s papules. Approximately 20% of patients with dermatomyositis reportedly show concomitant malignancies, including breast, colon, ovarian, and lung cancers [1]. We recently encountered a dermatomyositis patient with metastatic seminoma, which is extremely rare as an accompanying tumor. Of note was the finding that symptoms of dermatomyositis did not resolve with orchiectomy and steroids but resolved fully with chemotherapy started despite the unstable condition of the patient. We report here the unique clinical course of this patient with dermatomyositis accompanied by metastatic seminoma along with a review of the literature.
A 70-year-old man presented to the Department of Internal Medicine at our hospital complaining of muscle weakness of the extremities, erythema, and impaired gait, which had rapidly deteriorated since 1 month earlier. Muscle weakness was assessed as MMT 2/5, and he was bedridden with PS grade 3. Based on these clinical findings, dermatomyositis was suspected. Skin biopsy confirmed the diagnosis of dermatomyositis. Whole-body CT was performed as a routine screening for neoplasm, revealing a lesion in the left testis and systemic enlargement of the lymph nodes (Figure 1(a)). The patient was therefore referred to the Department of Urology with a diagnosis of paraneoplastic dermatomyositis with testicular tumor. Serum levels of CK and aldolase, both representing myogenic enzymes that serve as serum markers for dermatomyositis, were increased to 2621 U/L and 19.1 IU/L,
2
Case Reports in Urology
(a)
(b)
Figure 1: (a) Abdominal CT showing enlarged para-aortic lymph nodes. (b) After four courses of EP, enlarged lymph nodes have completely disappeared.
respectively. In terms of markers for testicular tumor, serum LDH was elevated to 1033 U/L, whereas HCG-𝛽 and AFP levels were within the normal ranges of
